Monday, 20 January 2014

THOMPSON, Circuit Judge. Twenty years after prison inmate Michelle Kosilek first requested treatment for her severe gender identity disorder, the district court issued an order
requiring the defendant, Luis S. Spencer, Commissioner of the Massachusetts Department of Correction (the "DOC"),1 to provide Kosilek with sex reassignment surgery. The court found that the DOC's failure to provide the surgery — which was said by a group of qualified doctors to be medically necessary to treat Kosilek's condition — violated Kosilek's Eighth Amendment rights. The DOC appeals the district court's order. Having carefully considered the relevant law and the extensive factual record, we affirm the judgment of the district court.

...
In 1992, Kosilek filed a pro se complaint against the DOC in the United States District Court for the District of Massachusetts.4 See Kosilek v. Maloney, 221 F. Supp. 2d 156 (D. Mass. 2002) ("Kosilek I"). Kosilek alleged the DOC was denying her adequate medical care in violation of the Eighth Amendment. Kosilek sought damages and an injunction ordering that she be provided with sex reassignment surgery....

Meanwhile, in December 2000, having not yet received the relief she was seeking, Kosilek filed this case — a second pro se lawsuit against the DOC and some of its medical providers. See
Kosilek v. Spencer, 889 F. Supp. 2d 190 (D. Mass. 2012) ("Kosilek II"). Again the gravamen of Kosilek's complaint was that the DOC was denying her adequate medical care in violation of the Eighth Amendment by not providing her with sex reassignment surgery. This case also went to Judge Wolf.
In February 2002, Kosilek's first lawsuit, Kosilek I, finally proceeded to a non-jury trial...

... the court found Kosilek had fallen short of establishing an Eighth Amendment violation because the subjective component of deliberate indifference had not been satisfied. Maloney, the court concluded, knew many facts from which he could have inferred Kosilek would suffer serious harm if her gender identity disorder was not treated, but he did not actually draw that required inference. Instead Judge Wolf found Maloney's refusal to allow Kosilek treatment was "rooted in sincere security concerns, and in a fear of public and political criticism as well."
The end result: because there was no Eighth Amendment violation, the court did not order the DOC to do anything.

Nonetheless, Judge Wolf expected it would do something. He wrote: "This court's decision puts Maloney on notice that Kosilek has a serious medical need which is not being properly treated. Therefore, he has a duty to respond reasonably to it. The court expects that he will."

In 2003, Dr. Seil made the same recommendation, indicating that Kosilek should be allowed to meet with a specialist after a year on hormones. Then in February 2005, the Fenway Center doctors indicated after evaluating Kosilek that she should be allowed to have surgery. Dennehy herself was Deputy Commissioner during Kosilek I and was involved in the decisions made in connection with that case. And right when she started as Commissioner, Dennehy slowed things down. She took the unusual step in assuming an active role in a de novo blanket reassessment of the treatment of those inmates suffering from gender identity disorder, including Kosilek, despite the fact that the DOC's contract with UMass provided that the UMass medical professionals would make the decisions about the medical care for inmates with this disorder and the Commissioner would only step in at the end to assess any security concerns.

The DOC explains away this delay by claiming that for a long time it did not understand that UMass recommended surgery for Kosilek, but the district court did not buy it.< br/>...
Thus, in the end, there was evidence that the DOC knew that Kosilek's medical providers were recommending surgery, and in response, the DOC dallied and disregarded. This behavior is significant, as in order to establish a subjective intent, "it is enough for the prisoner to show a wanton disregard sufficiently evidenced 'by denial, delay, or interference with prescribed health care.'" Battista, 645 F.3d at 453 (quoting DesRosiers, 949 F.2d at 19); see also Johnson v. Wright, 412 F.3d 398, 404 (2d Cir. 2005)(A "deliberate indifference claim can lie where prison officials deliberately ignore the medical recommendations of a prisoner's
treating physicians.").
...
Aside from the DOC's purported security concerns, the
court pointed to other evidence which it thought suggested the DOC's denial of surgery was not prompted by valid penological concerns but rather a deliberate indifference to Kosilek's medical
needs. For instance, there was evidence that the DOC did not leave things up to chance when it sought an opinion about whether an operation for Kosilek was even warranted. The DOC knew before it retained Osborne that she was assisting other departments of corrections in defending litigation filed by transgender prisoners.
In fact, Hughes specifically noted that Osborne would be more sympathetic to the DOC's concerns and that she did not believe that sex reassignment surgery was appropriate in the corrections
setting. It was not a stretch for the court to disbelieve Dennehy's testimony that Osborne's very predictable opposition to providing Kosilek with surgery did not play a role in her
selection.

The public disapproval of Kosilek's quest was another piece of the puzzle. Even though Dennehy and Clarke denied being motivated by avoidance of public controversy, the district court found this testimony lacking in credibility and concluded that Dennehy and Clarke were keenly aware of and in fact motivated by the outcry. Evidence supporting the court's finding included Dennehy's press appearance in the news piece featuring her senator
acquaintance who opposed the surgery; Dennehy's testimony that she was aware that some politicians were against Kosilek being provided with surgery and that she was generally aware of the negative news coverage; and Clarke's admission that he received the two letters from the seventeen unhappy state senators and twenty-five unhappy representatives.
...
It is enough that the district court had a reasonable basis for its perception
that the DOC had shown a pattern of "delays, poor explanations, missteps, changes in position and rigidities." Id. And as we chronicled above, there was ample evidentiary support for this
finding. Finding no clear error, we defer to the district court's assessment of Dennehy's and Clarke's testimony and the other evidence on the issue.

TLDR; - it's been 20 years with no end in sight because of deliberate delay due to personal, political and electoral unpopularity. Every stone has deliberately been left unturned.

A 46,XY mother who developed as a normal woman underwent spontaneous puberty, reached menarche, menstruated regularly, experienced two unassisted pregnancies, and gave birth to a 46,XY daughter with complete gonadal dysgenesis.

Klinefelter syndrome is a condition related to the X and Y chromosomes (the sex chromosomes). People typically have two sex chromosomes in each cell: females have two X chromosomes (46,XX), and males have one X and one Y chromosome (46,XY). Most often, Klinefelter syndrome results from the presence of one extra copy of the X chromosome in each cell (47,XXY).
...
Some people with features of Klinefelter syndrome have more than one extra sex chromosome in each cell (for example, 48,XXXY or 49,XXXXY). These conditions, which are often called variants of Klinefelter syndrome, tend to cause more severe signs and symptoms than classic Klinefelter syndrome
...
Some people with features of Klinefelter syndrome have the extra X chromosome in only some of their cells; in these individuals, the condition is described as mosaic Klinefelter syndrome (46,XY/47,XXY). Individuals with mosaic Klinefelter syndrome may have milder signs and symptoms, depending on how many cells have an additional X chromosome.

Monday, 13 January 2014

I'm not one to rail on about Gender Politics. I'm interested in Human Rights, especially as they effect Trans and Intersex people. I'm interested in the Science of Sex and Gender. The sociology, politics, and ideology, not so much. There's an awfully low signal-to-noise ratio there, unevidenced conjectures declaimed with much conviction, and often inhuman cruelty.

This blog is intended to be educational and informative, about a matter that should be of interest to everyone. A matter of "public concern", mixing education about the science, and information about how Trans and Intersex people are treated and all too often mistreated, not just in Australian Society, but worldwide. My audience is mixed, a large number of those directly affected, but also those who want to see improvement in the world, or are just plain curious about matters that seem inexplicable to many. A blog is an entirely appropriate way of reaching such an audience, either directly, or by providing a set of resources (mostly about the science) for others to make use of.

Most of my readers are neither Trans nor Intersex. Most of my friends are neither Trans nor Intersex. All of my friends, and the vast majority of readers, are rational people of goodwill. Some are on the Right, some on the Left, there are differences of opinion on many matters. Reasonable people can differ.

One problem I have, that many reasonable people of goodwill have, is that we're unaware of our privilege. The unearned advantages we have compared to others, that we consider only natural and right, and which we assume that everyone has. Everyone we know does, anyway.

This post is about cis-privilege. Now the majority of cis (pronounced "sizz" or "siss") people don't even know what the prefix cis- means. Latin scholars and chemists, and some English majors are the only ones who can be expected to know that cis- and trans- are opposites. Cis - same-side, Trans - across. Hence Cis-isomers and trans-isomers, CiaAlpine Gaul and TransAlpine Gaul, CisAtlantic and TransAtlantic.

CisGender and Transgender.

Cis-privilege is the set of advantages that cis- people have compared to trans- people, and that they're not aware of. Many fanatics vehemently deny that such a thing exists, or even can exist. There's a high correlation there with people who want to see trans people exterminated though. "Morally mandated out of existence" anyway.

Here's some examples from Gronkwena that illustrate cis-privilege beautifully. It's aimed at cis people. Please imagine if you were in a world where such educational posters were necessary, to educate rational, well-meaning trans people about those who are cis.

Now you know what "cis-privilege" means. It means such posters aren't necessary.

Sex in mammals is determined in the fetal gonad by the presence or absence of the Y chromosome gene Sry, which controls whether bipotential precursor cells differentiate into testicular Sertoli cells or ovarian granulosa cells1.
This pivotal decision in a single gonadal cell type ultimately controls
sexual differentiation throughout the body. Sex determination can be
viewed as a battle for primacy in the fetal gonad between a male
regulatory gene network in which Sry activates Sox9 and a female network involving WNT/β-catenin signalling2.
In females the primary sex-determining decision is not final: loss of
the FOXL2 transcription factor in adult granulosa cells can reprogram
granulosa cells into Sertoli cells2. Here we show that sexual fate is also surprisingly labile in the testis: loss of the DMRT1 transcription factor3 in mouse Sertoli cells, even in adults, activates Foxl2
and reprograms Sertoli cells into granulosa cells. In this environment,
theca cells form, oestrogen is produced and germ cells appear
feminized. Thus Dmrt1 is essential to maintain mammalian testis
determination, and competing regulatory networks maintain gonadal sex
long after the fetal choice between male and female. Dmrt1 and Foxl2 are conserved throughout vertebrates4, 5 and Dmrt1-related sexual regulators are conserved throughout metazoans3. Antagonism between Dmrt1 and Foxl2 for control of gonadal sex may therefore extend beyond mammals. Reprogramming due to loss of Dmrt1 also may help explain the aetiology of human syndromes linked to DMRT1, including disorders of sexual differentiation6 and testicular cancer7.

Monday, 6 January 2014

Disorders
of sexual development (DSD), ranging in severity from genital
abnormalities to complete sex reversal, are among the most common human
birth defects with incidence rates reaching almost 3%. Although
causative alterations in key genes controlling gonad development have
been identified, the majority of DSD cases remain unexplained. To
improve the diagnosis, we screened 116 children born with idiopathic DSD
using a clinically validated array-based comparative genomic
hybridization platform. 8951 controls without urogenital defects were
used to compare with our cohort of affected patients. Clinically
relevant imbalances were found in 21.5% of the analyzed patients. Most
anomalies (74.2%) evaded detection by the routinely ordered karyotype
and were scattered across the genome in gene-enriched subtelomeric loci.
Among these defects, confirmed de novo duplication and deletion events
were noted on 1p36.33, 9p24.3 and 19q12-q13.11 for ambiguous genitalia,
10p14 and Xq28 for cryptorchidism and 12p13 and 16p11.2 for hypospadias.
These variants were significantly associated with genitourinary defects
(P = 6.08×10(-12)). The causality of defects observed in 5p15.3,
9p24.3, 22q12.1 and Xq28 was supported by the presence of overlapping
chromosomal rearrangements in several unrelated patients. In addition to
known gonad determining genes including SRY and DMRT1, novel candidate
genes such as FGFR2, KANK1, ADCY2 and ZEB2 were encompassed. The
identification of risk germline rearrangements for urogenital birth
defects may impact diagnosis and genetic counseling and contribute to
the elucidation of the molecular mechanisms underlying the pathogenesis
of human sexual development.

Note:

incidence rates reaching almost 3%

the majority of DSD cases remain unexplained.

Most
anomalies (74.2%) evaded detection by the routinely ordered karyotype

I find it amazing that so many non-Intersex people are so vehement in
asserting that only *they* know who or what we *really* are. That their
opinion trumps our experienced narrative.
That might not be so bad if you could all agree with one another, but you can't.

Then
there's the overt homophobia - confusing us with gays. The overt trans-
and intersex-phobia, (often from gays ironically enough, who object to
being associated with us). They have a point - the only things we have
in common is that it's the same people who hate us both, and the fact
that Stonewall, the celebrated GLBT beginning of the fight for equal
rights, was largely led by Trans people. They've always been a part of
that, not "tacked on" as revisionist and comforting mythology would have
it.

Intersex people have in the past, largely been able to hide
instead. Not to make waves. Only the few (with 5ARD,17BHSD,3BHSD etc)
who physically change apparent sex during their lifetimes get the
problems Trans people do. That's 2% of live births in a few isolated
pockets on the planet, but exceedingly rare in the US. Maybe only a few
thousand.

For some, it's a descent into nightmare. For some, an
interesting life experience. For many, a release from the Hell of
(effective) transsexuality, neuro-anatomy of one sex, genital anatomy of
the other.

Our mere existence is against many strongly convicted religious people's most deeply-felt beliefs.

The article states : "While certain religious groups argue that sexuality is a choice (and
certain sexual lifestyles are therefore sinful), no one makes that
argument about biology."

I wish that were so. All too many
Charismatic Christians deeply believe in the power of Demonic Posession,
and consequently label Intersex people as Demonic, if not actual
Demons. To a lesser extent, Trans people too, a candidate for the
Colorado legislature, Gordon Klingenschmitt, recently labelled them as
"possessed by a spirit of Rape".on his syndicated TV show.

In summary - a quote from Dr Who:
"You know the very powerful and the very stupid have one thing in
common. They don't alter their views to fit the facts. They alter the
facts to fit the views. Which can be uncomfortable if you happen to be
one of the facts that needs altering."

I can attest to that discomfort.

All we can do is try
to inform, to educate, and rely on the general humanity and goodwill
present in nearly everyone. My faith in that has sometimes been sorely
tested, but remains battered but unbowed. Articles like this one help,
even though reading most of the commentary shows we have a long way to
go. Excelsior etc.

A human being should be able to change a diaper, plan an invasion, butcher a hog, conn a ship, design a building, write a sonnet, balance accounts, build a wall, set a bone, comfort the dying, take orders, give orders, cooperate, act alone, solve equations, analyze a new problem, pitch manure, program a computer, cook a tasty meal, fight efficiently, die gallantly. Specialization is for insects.
-Robert A. Heinlein

I prefer to live rather than die gallantly though. That's a last resort. Instead, I try to fight so efficiently that it's the other side that has to contemplate that. No matter, I intend winning. Consequences to myself are secondary. If a battle is worth fighting, win it, regardless of personal cost. If not, avoid it.

You see, RAH said something else too.

It may be better to be a live jackal than a dead lion, but it is better still to be a live lion. And usually easier.

Sunday, 5 January 2014

A TRANSGENDER woman has demanded an apology from bungling sheriff court workers who sent an offensive note with her divorce papers.
Becky Kent was stunned when she read a handwritten memo which officials had forgotten to remove from her paperwork. It was stuck on top of her divorce decree and sent to her.
The scribbled Post-it note read: “Colin it’s right!!! Man – changed his name to woman’s name – statutory declaration attached!!! Takes all sorts!!”
The letter had also been addressed “Dear Sir”.

Doesn't exactly give one warm fuzzies about being treated respectfully, does it? All too typical, I'm afraid.
Right now, very afraid in fact. Still, unless we fight this kind of thing, openly, with the more publicity the better, exposing it as a matter of public interest, it won't change.

Saturday, 4 January 2014

Sanders says the ruling will likely serve as an example when this issue comes up in other courts.
“Around the country there are probably more couples in this situation than many people realize.” Sanders says. “That is a couple who was male and female at the time being married and then one of them transitioned genders and many of them wished to stay married.”
Sanders says couples in this situation need confirmation their marriage won’t become void automatically if one of the parties undergoes a gender change.
Sanders says the Indiana appellate court’s decision is the first one documented involving gender change within a legal marriage.

Actually, I think there's another case in Florida.

Q: Is a marriage still valid if one spouse transitions
later on?

A: Marriages remain valid if they were valid at the time they were entered into. The government cannot retroactively invalidate a marriage because of a change in eligibility criteria that occurs after the marriage is entered into. Not even the federal Defense of Marriage Act (see sidebar for more about DOMA) should affect couples who are already married and were eligible for marriage at the time they entered into that relationship.
It’s an important principle to defend, especially in the face of openly anti-transgender policies and sentiments. That was the situation, for example, in 2007 when Lambda Legal represented a transgender man in a Florida alimony case known as Roach v. Roach n.k.a. Silverwolf. Julio Silverwolf(formerly Julia Roach) transitioned from female to male after 18 years of marriage to Lawrence Roach.
When the couple were divorcing, Roach argued that he shouldn’t have to pay alimony because Silverwolf was “legally dead” as a result of his transition and because Florida does not recognize marriages of same-sex couples. But the court upheld the alimony agreement, basing its ruling on the determination that the marriage was valid at the time it was entered into.

I have a letter from the Australian Attorney General (at the time) confirming that this is also the situation here. If legally Male and Female at the time the marriage was contracted, the marriage remains valid. Unfortunately there's caselaw stating that Intersex people, regardless of birth certificates or other documentation, are neither male nor female for the purposes of marriage, and so may not marry anyone.

Somehow it seemed as though the farm had grown richer without making the animals themselves any richer-except, of course, for the pigs and the dogs. ...

Today he and his friends had visited Animal Farm and inspected every inch of it with their own eyes, and what did they find? Not only the most up-to-date methods, but a discipline and an orderliness which should be an example to all farmers everywhere. He believed that he was right in saying that the lower animals on Animal Farm did more work and received less food than any animals in the county. Indeed, he and his fellow-visitors today had observed many features which they intended to introduce on their own farms immediately.

About Me

Actually, I am a Rocket Scientist.
Also hormonally odd (my blood has 46xy chromosomes anyway) and for most of my life, I looked male, and lived as one, trying to be the best Man a Gal could be. Anyway, in May 2005 that started changing naturally for reasons still unclear, and I'm now Zoe, not Alan : happier and more relaxed not to have to pretend any more.
UPDATE - reason now identified as the 3BHSD form of CAH.

Reviews

This blog, written by a rocket scientist, is a fascinating collection of information, both personal and scientific, regarding intersex, transsexualism and related psychosocial and psychosexual issues....It is erudite and heartfelt. Just read the posts about the passport issue. You won't know whether to laugh, weep or crawl into a ball and rock gently in a corner - an amazing person.- David---The reason I so appreciate bright, perceptive people - as opposed to ideologues whose intelligence does little to illuminate - is that they manage to both instruct and learn with a certain grace. Among such rarities in the transblogosphere is Zoe, whose direct speech and clear humanity always make her worth reading, even if one doesn’t always agree with her every conclusion.- Val---The following is a request for permission to archive your A.E.Brain blog site which we have wanted to do for several years...The Library has traditionally collected items in print, but it is also committed to preserving electronic publications of lasting cultural value....Since (1996) we have been identifying online publications and archiving those that we consider have national significance....We would like to include A.E.Brain blog site in the PANDORA Archive...-Australian National Library